Frailty predicts greater risk of dementia
Healthy lifestyle choices can reduce risk of frailty and dementia
Frailty can be regarded as the progressive accumulation of health deficits, such as mobility and hearing limitations, and depressive symptoms. Consequences of frailty may include loss of physiological reserve and increased risk of dementia. Would frailty predict risk of dementia for 8,722 older participants with an average of 64 years at baseline in the English Longitudinal Study of Aging? Researchers evaluated frailty using up to 47 factors and quantified the frailty index as the number of health deficits divided by the total number of potential health deficits considered for each participant.
Compared to non-frail participants, pre-frail and frail participants had significant 51 and 73 percent greater risks of developing dementia over follow-up of up to 10 years. Similarly, compared to non-frail participants at baseline, pre-frail and frail participants had significant 47 and 93 percent greater risks of dying during follow-up. Both analyses controlled for numerous confounding factors, including age, sex, and education. Also worth noting: Frail participants were significantly more likely to be in the lowest quintile of wealth, have no educational qualifications, and have a sedentary lifestyle compared to non-frail participants. The accumulation of health deficits in older people may produce a double whammy—both frailty and dementia.
A higher degree of frailty predicts increased risk of cardiovascular disease, mortality, cognitive impairment, and dementia, as well as reduced quality of life. Researchers in Canada used data from 196,123 participants with an average age of 64 years at baseline in the UK Biobank Study to determine if frailty, lifestyle behaviors, and genetics influenced risk of dementia over an average 8 years of follow-up. The absolute risk of developing dementia during follow-up was 3.8 times higher for high- as opposed to low-frailty participants, independent of genetic risk. Participants with both high frailty and high genetic risk had 5.8 times higher risk of developing dementia compared to participants with both low frailty and low genetic risk. In addition, non-frailty accounted for 44 percent of the protective effect of healthy lifestyle choices (not smoking, plenty of physical activity, a quality diet, moderate alcohol intake) with respect to risk of dementia. Thus, preventing frailty via better lifestyle choices, such as Keep Moving and Eat Better, would likely provide major health and well-being benefits.
Dementia may be a multi-factorial disease that arises from several health deficits that operate over time. Researchers in the UK used two-multifactorial variables, frailty and neuropathology, to determine their respective contributions to dementia. Participants over age 75 at baseline came from general practice registries in Cambridge, England, and were followed until death. The frailty index contained 39 items (deficits) related to progressive bodily system degeneration, while the neurodegeneration index included 15 factors. The frailty index was calculated as the number of deficits observed in a patient at the last examination before death divided by the number of possible deficits. A subset of participants (N=183) consented to brain autopsy at death.
Cross-sectional data showed that people with dementia had significantly less education, were frailer, have lower mental scores, and had greater neuropathology scores that people without dementia. Few people had little or no neuropathology at death. Both frailty (at the last examination before death) and neuropathology burden (at death) independently predicted greater risk of dementia (at last examination) after accounting for confounding factors. Assuming that severe frailty caused dementia and that frailty could be prevented at average of 5.6 years before death, an estimated 14 percent of dementia cases would be prevented. The authors urged a broader concept of dementia as the consequence of many small effects of various pathologies manifesting over time rather than a narrow focus on amyloid plaques and tangles. How about starting now to adopt healthy lifestyle choices to reduce your chances of frailty and dementia and increase your prospects of living life to the fullest?
